Gout is caused by a defect in metabolism which results in an overproduction of uric acid or leads to reduced ability of the kidney to eliminate uric acid. The exact cause is unknown. Risk is increased in males, postmenopausal women, and people with hypertension. Heavy alcohol use, diabetes, obesity, sickle cell anemia, and kidney disease also increase risk.

Symptoms of gout come on suddenly, usually involving only one or a few joints. The pain frequently starts during the night and is often described as throbbing, crushing, or excruciating. The affected joints show signs of warmth, redness, and tenderness. The pain tends to subside within several days. Chronic gout attacks, however, occur more often. If several attacks of gout occur each year this may cause chronic symptoms such as joint deformity and limitation of motion in affected joints.

Only a minority of patients with hyperuricemia develops tophi and gouty arthritis. Radiographs are not positive during the initial attacks but are useful in ruling out septic arthritis. Tophi in chronic gout can show irregular and asymmetric soft tissue swelling. The tophi can occasionally calcify. Bony erosion occurs in chronic cases and tends to be periarticular, well corticated and have a thin overhanging edge. There is no associated osteopenia.